UNIVERSITY OF PITTSBURGH AT GREENSBURG
2001-02 ELECTRONIC UNDERGRADUATE ADMISSION & FINANCIAL AID FORM

PERSONAL DATA

All data collected on the Application Form is private and confidential. The information collected from you will be used only internally and will not be released to persons or institutions outside the University of Pittsburgh without your written consent. Once your electronic application is received, we will contact you regarding the method of payment for the $35.00 application fee.

1.) Name (Last name, first name, middle initial): 
Social Security #: 

2.) Previous name (If any of your records are under a name other than the one given above please indicate) : 

3.) Permanent Address & Phone:
Street, P.O. Box, etc.: 

City: State: Zip: 

Area Code and Phone #: 

4.) Temporary Address & Phone: (Until what date): 
Street, P.O. Box, etc.: 

City: State: Zip: 

Area Code and Phone: # 

4.a) E-mail Address: 

4.b) Are you a resident of Pennsylvania?

YES, More than one year YES,Less than one year NO

Is your Father/Guardian a resident of Pennsylvania?

YES, More than one year YES,Less than one year NO

Is your Mother/Guardian a resident of Pennsylvania?

YES, More than one year YES, Less than one year NO

4.c) Give the complete address of any residence(s) you have had during the last twelve months:

5.) Name of (Check one): FatherGuardianGrandfatherStepfather

6.) Name of (Check one): MotherGuardianGrandmotherStepmother

7.) Name of spouse (if married): 

8.) Family members who are Pitt Alumni: FatherMotherBrotherSisterSpouseOtherNone

 9.) Student citizenship: U.S. CitizenU.S. Immigrant/Permanent Resident AlienRefugeNon-immigrant

 Your response to questions 10-12 is voluntary, will be kept confidential, and will not be used to deny access or admission. The information will, however, assist the University in providing data to demonstrate compliance with federal regulations.

 10.) Date of birth:11. Sex:FemaleMale

 12.) Race/ethnic group:BlackAsian/Pacific IslanderAmerican Indian/Alaskan NativeHispanicWhite
 
 

ADMISSIONS/FINANCIAL AID INFORMATION

Applying for financial aid will in no way influence your status as an applicant for admission to the University.

 14.) Have you previously applied to the University of Pittsburgh?YesNo
Term: Year:

 15.) Have you ever enrolled at the University of Pittsburgh?YesNo
Campus: Year: 

16.) Are you currently attending the university of Pittsburgh?YesNo
Campus: Year: 

17.) Applying for term beginning:Fall (August)Spring (January)Summer

 18.) Applying for year beginning (year):

 19.) Status for which applying: (Assume 3 credits per class: 12 credits would equal full-time.)
Full-timePart-time

 20.) Expected date of graduation from the University (Month and Year):

21.) Enter your intended field(s) of study:(Multiple items may be selected by holding down the Ctrl key)


(1) Four-year major available at Greensburg.
(2) Final four years, of the six-year program, to be completed on the Pittsburgh Campus.
(3) Final two years to be completed on the Pittsburgh campus. The minimum grade average required for relocation may vary from program to program.
(4) Final two and one-half to three years to be completed on the Pittsburgh campus. The minimum grade average required for relocation may vary from program to program.
 

22.) Please list in chronological order every high school, post-secondary school, college or university you have attended, the addresses and dates attended.
Name of school - Address: Dates Attended: 
Name of school - Address: Dates Attended: 
Name of school - Address: Dates Attended: 
Name of school - Address: Dates Attended: 
Name of school - Address: Dates Attended: 

23.) Indicate the campus to which you are applying.
PittsburghBradfordGreensburgJohnstownTitusville

  24.) Do you desire University Housing?YesNoCommute from Parent's HomeOff-Campus

 25.) County of residence.

26.) Do you wish to be considered by the University for Financial Aid?YesNo

 27.) At which academic level do you expect to enroll?
FreshmanSophomoreJuniorSeniorFifth Year

 28.) Expected credit load. To be filled out by part-time students only.
credits Fall Term: credits Spring Term: credits Summer Term: 

29.) Indicate when you have taken or when you will be taking (or retaking) the required entrance examination.
Name of Test Date(s) Taken Date(s) Will Take
Scholastic Aptitude Test:
American College Test
Test of English as a Foreign Language

30.) Current High School Students Only
Please list all courses you will be taking as a high school senior.

31.) Transfer Candidates and Pitt Students
List all courses in which you are currently enrolled and/or plan to complete prior to transfer.

Number of college credits completed to date:

Cumulative grade point average:

Number of credits for which you are currently enrolled:

Number of credits you plan to take at your present college or university after this term, but prior to your enrollment at Pitt. (if applicable): 

PERSONAL ESSAY

The following is optional, but recommended. It is highly recommended if you want scholarship consideration or if you feel that your application warrants special consideration. (The Personal Essay may be submitted when you send your application fee. Enter To be submitted later in the area below.) Select one of the following:

 A.) Submit a sample of you writing, for example, a paper or essay already written.
B.) Imagine you're on the Admissions or Scholarship Committee. Take a close look at your records. Now tell us something about yourself that isn't apparent from your academic records--something that will give us insight about you as an individual and might help in the Committee's decision.
C.) If you've been out of school for a while, what are some of the experiences (work, personal, etc.) you've had and what interested you in returning to school.

I understand this electronic application for admission to the University of Pittsburgh will not be complete until I have submitted my final high school transcript, upon graduation, (or my official satisfactory G.E.D. test result) and, if I am a transfer applicant, all final, official post-secondary transcripts. I understand the University will prevent my registration and /or graduation from the University should these documents not be provided.

 Name of Applicant: Date: 

The University of Pittsburgh is an affirmative action, equal opportunity institution.